1.Psychometric Properties of the Mixed State Severity Index for Patients With Mood Disorder
Woojae MYUNG ; Hyeona YU ; Hyo Shin KANG ; Daseul LEE ; Junwoo JANG ; Jakyung LEE ; Joohyun YOON ; Yun Seong PARK ; Hyun A RYOO ; Ye Rim KIM ; Kwang Ho PARK ; Chan Woo LEE ; Yoonjeong JANG ; Kimyoung KIM ; Nara LEE ; Sanghoon HONG ; Hong-Hee WON ; Tae Hyon HA ; Jungkyu PARK
Psychiatry Investigation 2026;23(1):106-117
Objective:
This study aimed to develop a reliable and valid Mixed State Severity Index (MSSI) to assess mood instability in patients with mood disorders and determine cutoff scores.
Methods:
Twenty-one items were selected based on Koukopoulos’ criteria for mixed depressive episode, historically referred to as agitated depression, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision mixed features criteria. The MSSI was administered to 242 patients (major depressive disorder [n=92], bipolar disorder [BD] I [n=78], and BD II [n=72]) and 726 controls.
Results:
The MSSI demonstrated high internal consistency (α=0.78–0.90). Exploratory factor analysis revealed a stable four-factor structure. Based on receiver operating characteristic analysis, optimal cutoff scores were identified to distinguish mood disorder groups from controls, ranging from 19.5 to 27.5 depending on diagnosis.
Conclusion
The MSSI is a reliable and valid instrument for assessing the severity of mixed features in patients with mood disorders. The established cutoff scores enhance its clinical utility, providing robust diagnosis and treatment planning support.
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